{include file="$g_template/_fronthead.tpl"}

<div id="wrap_5">
		<div id="header">
			<div class="logo"><img src="{$g_image}/logo.png" width="77" height="72"></div>
			<div class="welcome"><img src="{$g_image}/welcome.png" width="200" height="47"></div>
		</div>
        
        {include file="$g_template/_mainmenu.tpl"}
        
	<div id="web_content">
		<div class="title_content_detail">Payment<br><span style="font-size: 16px;">{$now}</span></div>
		<div class="line"></div>
		<div class="text_description">
			<p style="margin-top:5px; margin-left:45px;">กรุณาระบุ Pre-auth ID ที่ต้องการทำ Payment</p>
		</div>
		<div class="search">
			<div class="form_search">
			<form name="frmPayment" id="frmPayment" method="post" action="javascript:;" >
				<table width="600" border="0" align="center" cellpadding="1" cellspacing="1"">
					<tr>
						<td colspan="3" align="center" height="60px;">&nbsp;</td>
					</tr>
					<tr>
						<td width="50">&nbsp;</td>
						<td width="500" align="left">
							<span style="font-family: sans-serif; font-size: 20px; font-weight: bold; margin-left: 20px;">
								<input type="radio" name="rdo_payment" id="rdo_pa" value="1" checked> ประกันอุบัติเหตุ (PA)
							</span></td>
							<td width="50">&nbsp;</td>	
					</tr>
					<tr>
						<td width="50">&nbsp;</td>
						<td width="500" align="left">
							<span style="font-family: sans-serif; font-size: 20px; font-weight: bold; margin-left: 20px;">
								<input type="radio" name="rdo_payment" id="rdo_er" value="2"> ประกันสุขภาพ อุบัติเหตุฉุกเฉิน (Health-ER)
							</span></td>
							<td width="50">&nbsp;</td>	
					</tr>
					<tr>
						<td width="50">&nbsp;</td>
						<td width="500" align="left">
							<span style="font-family: sans-serif; font-size: 20px; font-weight: bold; margin-left: 20px;">
								<input type="radio" name="rdo_payment" id="rdo_opd" value="3"> ประกันสุขภาพ ผู้ป่วยนอก (Health-OPD)
							</span></td>
							<td width="50">&nbsp;</td>	
					</tr>
					<tr>
						<td colspan="3" align="center">&nbsp;</td>
					</tr>
					<tr>
						<td colspan="3" align="center">&nbsp;</td>
					</tr>
					<tr>
						<td>&nbsp;</td>
						<td align="center">
							<input type="hidden" name="hid_userid" id="hid_userid" value="{$_profile->userid}">
							<input type="hidden" name="hid_preauth_datefrom" id="hid_preauth_datefrom" value="{$today}">
							<input type="hidden" name="hid_preauth_dateto" id="hid_preauth_dateto" value="{$today}">
							<input type="button" name="btn_payment" id="btn_payment" value="ค้นหา" style="width:130px; height: 30px; font-size: 16px;" onclick="_renderPaymentList();">
							<a id="link_payment_list"></a>
						</td>
						<td>&nbsp;</td>
					</tr>
				</table>
				</form>
			</div>
		</div>
		
		</div>
	
{include file="$g_template/_frontfoot.tpl"}